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Advanced Reproductive Care, Inc. (ARC) is the nation's largest network of Reproductive Endocrinologists that is committed to providing affordable packages and financial solutions that help overcome insurance limitations. For the past 10 years ARC has helped thousands of couples realize their dream of having a baby.

Advanced Reproductive Care, Inc. (ARC)^®
20665 Fourth Street, Suite #201
Saratoga, CA 95070

Toll Free: 1-888-990-2727

Please fill out the following questionnaire to find out how The ARC Fertility^© program can work for you and to receive additional information.

Be assured that your information is secure and confidential
and will be used only by Advanced Reproductive Care, Inc.

* Required Fields

First Name:	*
Last Name:	*
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1. Do you have a fertility doctor?* Yes, write the name of the doctor: No, but would like a referral to a doctor in my area.
2. Do you know what type of treatment you are seeking? * if Yes, select from menu
3. How soon do you anticipate starting treatment?*
4. I am interested in... (check any that apply)* Affordable quality care and predictable pricing Treatment financing and payment plan options Refund Guarantee for Fertility Services Referral to a board-certified Reproductive Endocrinologist Other:
5. How did you first learn about us? (Answer all that apply)* Physician or clinic/medical group referral: (indicate which one) ARCfertility.com Web search (Google, Yahoo, Ask) Print advertisement, which: Friend, word-of-mouth
6. To better assist you, any additional questions or comments are welcome (optional).


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